Increasing benzodiazepine prescriptions have clinical relevance amid declining life expectancies and a global epidemic of opioid overdoses. When benzodiazepines are taken alone, long-term use is associated with falls, cognitive impairment, and life-threatening withdrawal.1,3 When taken together with opioids, benzodiazepines can further suppress breathing, a common cause of death from opioid overdose.1,6,7 The danger of benzodiazepine-opioid cotreatment is thus a timely issue, as 20% to 30% of all benzodiazepine recipients in the US are estimated to have an opioid coprescription8 and more than 30% of opioid overdose deaths are found to involve benzodiazepines.9,10,11 Despite a recent plateau in overall opioid use in the US,8,12,13 benzodiazepine-opioid coprescriptions continue to increase.2,8,14,15,16 It is tempting to infer elevated mortality risk attributable to benzodiazepines alone or in combination with opioids, but this topic has proven challenging to study. To date, it is not well understood if benzodiazepine use—whether with or without opioids—is associated directly with mortality, as opposed to serving as a marker for unmeasured underlying conditions that are the true factors associated with excess deaths.
